Rational Use Of Blood Research Articles

Use of educational manuals on blood components in hemotherapy and hematology services in Brazil: a scoping review

Hemotherapy has as its principle the rational use of blood, consisting of the appropriate use of blood components such as red blood cells, platelets, plasma and cryoprecipitate, obtained from the donation of whole blood. The use of educational manuals stands out as support in this process, which helps in the organization and safety of transfusion practice. The objective of the study was to map educational manuals on blood components in hemotherapy and hematology services in Brazil. This is a scoping review based on the recommendations of the Joanna Briggs Institute (JBI) and structured based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoing Reviews (PRISMA-ScR) checklist and was registered in the Open Science Framework, under DOI: 10.17605/OSF.IO/642JZ. The publications had a predominance of articles in Portuguese language 100%. There was a prevalence of studies with a descriptive approach 80%, action research 10% and randomized studies 10%, as well as publications carried out in Brazil 100%. The study showed us the importance of manuals and the difference caused by their use in terms of standardization in Brazilian health units.

Transfusion Camp Rwanda 2023: A train-the-trainer workshop establishing locally driven leadership in knowledge translation and sustainability in transfusion medicine education.

Blood transfusion is performed daily in hospitals. Gaps exist between transfusion guidelines and day-to-day clinical care. These gaps are prevalent in resource-limited settings due to scarce continuing medical education. Transfusion Camp Rwanda aims to bridge this gap by (1) delivering context-appropriate up-to-date education, (2) teaching participants how to independently deliver a case-based curriculum and (3) identifying strategies to promote change in transfusion practice in Rwanda. In May 2023, a multidisciplinary team from Canada and Rwanda carried out a Transfusion Camp train-the-trainer workshop for clinicians from all five provinces in Rwanda. Participants attended in-person lectures, seminars and workshop group discussions on the implementation of the Rwanda National Directives on Rational Use of Blood and Blood Components. Course feedback was based on the Kirkpatrick Model of Training and Evaluation. Fifty-one physicians and laboratory technicians participated in the course. Confidence in caring for patients based on transfusion guidelines was self-rated as 'excellent' by 23% of participants before and 77% after, while 84% reported they planned to teach Transfusion Camp to others and 100% responded that they will apply course content to clinical practice. Workshop groups recommended strategies to improve transfusion medicine practice in Rwanda in four domains: Communication, Institutional Approval, Practice Audits and Education. Transfusion medicine education in Rwanda using a train-the-trainer approach was well-received by participants and allowed for a more detailed understanding of the local medical and educational environment. These observations can inform the further expansion of the Transfusion Camp Rwanda project.

Blood Products Wastage in Benghazi Hospitals, Libya: The Rate and Causes

Abstract Introduction/Objective Introduction: Despite the rising demand for blood and blood products, supplies are limited. Limiting blood wastage may compensate for fewer donors. This study examines blood waste in Benghazi. A close look at blood and blood product distribution can reveal areas of frequent wastage and the primary factors contributing of blood waste. This would aid in the development of waste prevention programs and raise awareness of the issue. Physicians, laboratory professionals and nurses can follow blood transfusion guidelines. Objectives: This study aimed to determine the rate of blood products wastage and identify the causes of Wastage in Benghazi hospitals in Libya. Methods/Case Report Materials and Methods: Data for this retrospective study describes the blood components utilization or waste for two years: 2015 and 2016 were obtained from hospital blood bank records of all public and private hospitals that Benghazi central blood bank supply with blood and blood components. Descriptive statistical methods analyzed the data. Results (if a Case Study enter NA) Results: In 2015 and 2016, Benghazi central blood bank supplied hospitals with 73511 units of blood. 35107(47.8%) were transfused. Wasted or discarded 33318(45.4)units. No data was available for 5086 units(6.8%). The most frequently wasted component was PRBCs(87%) followed by platelets(8%) and FFP(6%). The major cause of wastage for PRBCs is over-ordering (70.2%) followed by outdated units(18.5%), Returned after 30 minutes of issue (0.6%), Kept more than 3daysand expired(0.6%) and Issued to other hospitals(10.1%). The main cause of wastage for platelets is over-ordering (89%), and inappropriate ordering is the most common cause of waste of FFP(85%). PRBCs waste was mostly found in the surgical department, mainly obstetric(24%). For platelets, waste was mostly found in the hematology department(32%). for FFP, waste was mostly found in ER(47.1%). Conclusion The main cause of blood and blood component wastage is the unnecessary ordering of blood products. The most blood component discarded is PRBCs. Physicians are the most responsible for blood and blood component wastage. The blood ordering pattern needs to be revised, and the over-ordering of blood and blood component should be minimized. Medical staff must be educated to reduce blood wastage. Every hospital should implement a hospital transfusion committee to develop local guidelines and policies to monitor the rational use of blood and blood component.

The Role of Hospital Transfusion Committee in Ensuring Rational Use of Blood

A Hospital Transfusion Committee (HTC) is a governance body established within the hospital to ensure appropriate blood product use, auditing blood use in the hospital and monitoring and preventing adverse events. The primary goal of HTC is to promote the safe and effective use of blood and components. It is important to educate the end users of blood components to close the gap in medical education pertaining to transfusion medicine. Comprehensive blood utilization review and reporting to management ensures that corrective actions are taken when needed. Meeting is held annually in our setting to discuss practices within the hospital and scope of improvement. HTC provides an active forum for communication between staff directly involved in clinical and laboratory-based patient blood management and blood transfusion activities, to provide solutions, feedback and education in relation to identified problems and to ensure that transfusion practice accords with best practice and aligns with national standards.

Rational use of blood and blood components in a Tertiary Care Hospital: A Crossectional study.

Rational use of blood and blood components in a Tertiary Care Hospital: A Crossectional study.

Patient blood management strategies in vascular surgery

Transfusion of blood components can save lives, but like all therapeutics, it carries risks and costs. Therefore, transfusion should be used judiciously. Patient blood management provides safe and rational use of blood and blood products and is designed to improve patient outcomes by minimizing unnecessary exposure to blood products. In this review, perioperative patient blood management and techniques to minimize blood loss during vascular surgery are discussed.

Evaluation of Blood Requisition Forms Submitted to Transfusion Medicine Department of a Tertiary Care Hospital in Dhaka, Bangladesh

Introduction: Blood requisition form (BRF) analysis is one of the most efficient and effective approaches to assess and monitor rational use of blood and its product. BRF is the first line of communication between the clinicians and transfusion medicine specialists which helps to recognize and evaluate inappropriate use of blood. This issue is frequently underrated by the clinicians which results in increased risk of inappropriate transfusion. The current study is aimed to examine the pattern of completion of blood requisition forms and to ensure safe blood transfusion. Materials and methods: This cross sectional prospective study was conducted from January 2020 to December 2021, at the Department of Transfusion Medicine, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh. A total of 32,133 blood requisition forms that were submitted during the study period were compiled and reviewed anonymously. The data were analyzed using Microsoft Excel. Results: During the study period, a total of 32,133 Blood requisition forms were analyzed. Only 15.2% of these forms were duly completed. Rest of the forms had one or more important parameters left blank. The most common incomplete BRF items were the clinical history or differential diagnosis of the patient (52.66%), presumed date and time of transfusion (95.19%), previous transfusion history (95.9%), and referring doctor’s name and designation (88%). Blood requests were more for females (52.02%) than males (47.98%) during the period. Requisitions were more for adults (90%) than pediatric patients. Conclusion: The current study provides evidence that the rate of completion of BRFs is not satisfactory. The request forms evaluated were not covering acceptable demographic and clinical data of the patients. Both the Hospital Transfusion Committee (HTC) and the Department of Transfusion Medicine can help to improve and standardize transfusion practice by working together. Sir Salimullah Med Coll J 2022; 30: 142-147

Utilization of Blood and Blood Components in a Tertiary Care Hospital at Bogura, Bangladesh

Background and Objectives: Blood and blood components should be transfused cautiously due to potential risks of various transfusion reactions. It is very important for clinicians to be aware of these potential risks. Great progress had been made in the 20th century, by introducing blood component therapy. Now the term “Rational use of blood” came forward. Hence, indiscriminate use of whole blood (WB) should be avoided or minimized. The aim of our article is to demonstrate and evaluate the quantity and pattern of components used in our hospital. Materials and Methods: A retrospective study was carried out in the Department of Transfusion Medicine at a Medical College Hospital from July 2021 to December 2021. Transfusion details were obtained from blood bank records for each patient. Data of all the used blood and components were evaluated and analyzed. Results: Among the male recipients, the majority was of the age group <10 and >50 years, whereas among females, the majority were of age 21–30 and then >50 years. The majority of used blood units were WB (76.48%) followed by red cell concentrate (22.23%) and then platelet concentrate (0.94%). Fresh frozen plasma and cryoprecipitate were not used. The majority of WB was used in patients of trauma or fracture (17.57%), followed by pregnancy-related cases (17.23%), malignancy (10.20%), kidney diseases (7.43%), and others. Conclusion: The use of WB was the most predominant in spite of prevailing facilities for component preparation in our hospital. Our physicians should be oriented to consider and utilize the advantages of using blood components.

Blood Transfusion Audit in Tertiary Care Hospital Blood Bank

Blood transfusion is lifesaving procedure in critical conditions like road accidents, postpartum hemorrhage etc. hence the rational and appropriate use of blood and blood products is very essential step to save life of many patients with available blood products in any blood bank. The purpose of a transfusion audit is to determine the appropriateness of blood transfusion practices, and provide data for the improvement of blood transfusion services. For the rational use of blood, it is essential to collect information about existing blood transfusion practices. In this study, an attempt was made to analyze and study the pattern of blood utilization among the various medical and surgical specialties of tertiary care hospital. A study was conducted on all the blood requisition forms received at the blood bank of tertiary care hospital during the period January 2017 to December 2021. The records of the blood issued to the patients were studied. Out of total 14028 units cross-matched, 6374 units (45.43%) were issued. Out of total 14028 requests, 5009 were for single unit of which 1480 units (29.54 %) were utilized. The transfusion committee in the hospital should conduct regular audits in order to achieve utmost efficiency and numerous benefits, in terms of workload, cost, errors of transfusion and betterment in patient services. It should develop and amend the policies time to time to abolish inappropriate transfusion practices.

Blood supply management amid COVID 19 pandemic: Challenges and strategies.

ABSTRACTBackground:Blood supply management amid the coronavirus disease 2019 (COVID-19) pandemic became a cause of concern. Blood donations in the pandemic reduced significantly because of travel restrictions and fear of contracting the virus by visiting blood banks. The WHO (World Health Organization), NACO (National AIDS Control Organization) and the SBTC (State Blood Transfusion Council) published guidelines to ensure the safety of blood donors and staff during the pandemic and to ensure correct procedures are followed. The blood centre physicians took measures for appropriate clinical use of blood and blood products, which reduced the number of transfusions and thereby safeguarded the blood supply for those who needed it the most.Materials and Methods:The study was conducted at the All India Institute of Medical Sciences, Bhopal, and 33 blood banks from 33 districts of Madhya Pradesh in collaboration with the National Health Mission and NACO. This was a retrospective study from pre-lockdown to lockdown and unlock phases 1 to 5 for nine months (February 2020 to October 2020) from 33 district-level blood centres of Central India, and the study compared the impact on blood supply from pre-pandemic time to the COVID-19 pandemic time. During the stipulated time period of 9 months, which included the pre-pandemic blood supply, the phases of lockdown when Section 144 was imposed in the country and the unlock phases, the management of transfusion services by the district blood banks of Central India during the COVID-19 pandemic was evaluated. The strategies adopted to maintain the blood supply and adequate inventory were studied.Results:The blood donation percentage in the district hospitals of Madhya Pradesh dropped drastically by 61.5% in February 2020 (pre-pandemic time) to 3.35% in April 2020 (COVID-19 pandemic). The nadir of fall in blood donations was seen in April 2020 (phase 1 of COVID-19 pandemic lockdown) with a zenith in February 2020 (pre-pandemic time). The minimum number of donations 8,037 (3.32%) in all 33 districts of Central India was seen in April, when the lockdown restrictions in the country were the strictest. In response to the reduced blood supply, the blood centres adopted strategies to maintain the inventory. Routine requests and inventory were monitored strictly for judicious and rational use of blood and its components.Conclusion:The motivation, dedication and the judicious use of blood products in addition to blood conservation strategies, first-in-first-out policy, maintaining an emergency stock of blood and strict monitoring by blood centre physicians led to the gradual upward trend of blood stocks, and hence blood supply management amid the COVID-19 pandemic could be sustained.

English

English

>Metodologias ativas para a cultura de segurança

Introduction: The promotion of the patient safety culture makes part of the strategies proposed in the National Patient Safety Program. Objective: This paper presented the experience of the Patient Safety Nucleus during 2018 in promoting the patient safety culture. Method: The use of active learning methodologies in a medium-sized public hospital in Minas Gerais, that belongs to the Sentinel Network of Anvisa. Results: The “10 Goals – Patient Safety” campaign originated after the identification and prioritization of the macroproblems related to patient safety in the institution. The 10 goals defined were: 1) Effective communication; 2) Fall prevention; 3) Safe surgery; 4) Prevention of pressure injury; 5) Safe use of probes and catheters; 6) Safe identification; 7) Drug safety; 8) Clean and safe care; 9) Patient involved; and 10) Safe and rational use of blood. The structuring of educational strategies was based on active learning and problematization methodologies. Conclusions: It was observed that the use of active methodologies can stimulate and induce employees and users to discuss and know the meaning of the hospital safety culture.

A step toward bloodless medicine and surgical practice will lead to rational use of blood: A literature review

A step toward bloodless medicine and surgical practice will lead to rational use of blood: A literature review

Assessment of the knowledge and perceptions of Brazilian medical residents on transfusion medicine

BackgroundMedical education has a major social impact because it ultimately influences the quality and safety of the health service offered to the population. Several studies have acknowledged the relationship between medical knowledge on transfusion medicine and the proper use of this therapy. The rational use of blood has become a worldwide concern. In this context, the aim of the present study was to evaluate medical residents’ knowledge on transfusion medicine in hospitals located in Rio de Janeiro, Brazil, and their training during their medical education. MethodsOne hundred and six residents from eight medical specialties of four hospitals participated. A questionnaire developed by the Biomedical Excellence for Safer Transfusion (BEST) group was applied to evaluate the participants’ medical knowledge. Another questionnaire was also applied to evaluate participant profiles regarding frequency of transfusion prescriptions, self-perceived knowledge and relevance of the subject. ResultsThe mean number of correct answers to the questionnaire on knowledge about transfusion practices was 43.5% (range: 15–80%). A relationship between training during medical residency and the obtained result was observed (p-value=0.0007). Most residents (73%) did not receive training in transfusion medicine during their graduation or residency and 93% would like to receive additional training. ConclusionA clear deficit in the knowledge of transfusion medicine was verified, indicating the need for change in the teaching of this specialty. This result is similar to some developed countries.

Implementing a patient blood management programme in Brazil: challenges and implications for developing countries

BackgroundPatient blood management (PBM) programmes have the intention of promoting the rational use of blood, relying on up‐to‐date medical‐scientific evidence in a multidisciplinary approach, where the patient is the main focus of transfusion decisions. These programmes not only increase patient safety levels, but they also have the potential of lowering hospital costs. The aim of this study was to describe the implementation of a PBM programme at a University hospital in Brazil.Study design and methodsThe discussions regarding this PBM project were initially undertaken among the managers of the hospital's Transfusion Unit. Audits of transfusion practices were carried out, and these indices were presented in meetings with the Transfusion Committee and with other important stakeholders, in order for this information to support the delineation of the programme's work fronts.ResultsThe project was promptly approved by the hospital's Board of Directors due to the relevance of the proposal, which required few financial resources as the project is mainly based on reorganization of workflows. The measures implemented included the following: didactic sessions aimed at the hospital staff, reformulation of the computerized system for the prescription of blood components, elaboration of a protocol for the use of antifibrinolytic drugs during the perioperative period and the institution of an outpatient clinic for evaluation of preoperative anaemia.ConclusionThe benefits and challenges of a PBM project in a country with limited resources are analysed, discussing specificities in the scope of Brazilian Transfusion Medicine in a pioneering way.

Seroprevalence of transfusion transmissible infections among blood donors by chemiluminescent assay in a tertiary care centre

Blood transfusion is a life saving measure, but also carries risk of transfusion transmitted infections (TTIs). In spite of improved donor screening, risk of transmission of TTIs still remains a major concern. Stringent screening of blood not only ensures safe supply of blood and blood products, but also gives us an idea about prevalence of TTIs among general population. Blood donors (voluntary and replacement), fulfilling national and regional blood bank criteria, attended our blood bank, during Jan 2015-Dec 2016 (included). Retrospective data analysis was performed by a structured database. After obtaining informed consent, venous blood was collected and analysed for HBsAg, anti-HCV and Anti-HIV1 and 2 (Chemiluminescent assay -OrthoVitrosECi/ECiQ), Malaria (ICT-pf/pan-Alere) and Syphilis (RPR-Labcare Dignotics). A total of 9027 donors were screened; Males and females were 99.23% and 0.76% respectively with the mean age of 27.4 ± 2 years (19-58 years). Voluntary donors were 68.7%; replacement donors 31.3%. Voluntary donation increased by 3% in 2016 (69.7%) vs 2015 (67.1%). TTI prevalence was 1.12% (102/9027). Surprisingly prevalence was higher among voluntary donors, females and 21-30 years. Seroprevalence of HBV (0.42%), HIV (0.13%), and Malaria (0.01%), in our region was relatively inferior than other parts of country. Nonetheless, HCV (0.56%) infections were on the rise. No syphilis case was reported. Low seropositivity rate is believed to be attributed to improved counselling of blood donors, adherence to standard donor selection criteria and rational use of blood. Even though low prevalence, effective control strategies including stringent screening, implementation of more sensitive tests and health education are urgently needed to prevent those TTIs.

Patient Blood Management – from local initiatives to European collaborations

Patient blood management (PBM), as defined by the WHO, is a patient‐focused, evidence‐based and systematic approach to optimize the management of patient and transfusion of blood products for quality and effective patient care. It is designed to improve patient outcomes through the safe and rational use of blood and blood products and by minimizing unnecessary exposure to blood products. Important elements of PBM are optimizing haemoglobin concentrations without blood transfusion, minimizing blood loss and managing anaemia, especially by use of evidence‐based transfusion guidelines and pharmacological agents. Local PBM initiatives differ substantially. In one region of Denmark, the majority of PBM initiatives over the last 10 years have been based on provider education and enforcement of national guidelines. Evaluation of the effect of these initiatives indicated that education alone can be an effective and durable method of reducing unnecessary transfusions. To improve implementation and knowledge of PBM, benchmarking of experiences between hospitals and countries seems rational, and several initiatives regarding PBM are being undertaken in Europe. Patient Blood Management in Europe (PaBloE) is a working group of the European Blood Alliance. Its objectives are to derive good practices in PBM and to develop ways to implement these practices. Within this group, several surveys have been performed relating to blood product consumption, implementation of PBM, and knowledge of PBM principles and practices among clinicians. These surveys have shown variation in transfusion rates between the participating hospitals, and variable implementation of PBM activities and monitoring of transfusion practice.

Rational Clinical Use of Blood and Blood products – A summary

Blood transfusion is an essential therapeutic intervention. The main role of the blood centre is to provide safe and timely blood and blood component(s) to the patients that will improve the physiological status of the patient. Various blood components can be harvested from a single donation of whole blood. The blood centre ensures that there is an adequate inventory of all blood types and blood components to meet the needs of the patients. The blood centre does donor selection, blood collection, component preparation, screening for transfusion – transmitted infections and blood processing. Serologically compatible blood and components are provided to the patients after meticulous pre-transfusion testing as per the standard protocol. Rational use of blood and blood products means right product is used with the right dose on right time for the right reason.

Progress of perioperative transfusion therapy for cancer patients

Background Perioperative transfusion in patients with malignant is a major problem in clinical practice. In recent years, numerous studies have shown that perioperative transfusion lead to immune suppression, recurrence and metastasis, which reduced the survival rate. Therefore, clinicians paid more attention to transfusion therapy and tumor-related issues. Objective Raising awareness of reasonable perioperative transfusion for the patients with malignant tumor, further implementation of rational use of blood. Content Progress of perioperative transfusion in patients with malignant tumor. Trend Perioperative transfusion for patients with malignant tumor should be based on the evaluation about the risk-benefit ratio. We should emphasize the rational use of blood, use a variety means of blood protection method, reduce the unnecessary transfusions. And so we can improve long-term prognosis of patients with malignant tumor. Key words: Malignant tumor; Perioperative; Blood protection; Transfusion

Blood transfusion safety; current status and challenges in Nigeria.

The attainment of blood transfusion safety in Nigeria (and probably the rest of Sub-Saharan Africa) remains an uphill task due to a number of factors, ranging from shortage of blood, poor implementation of blood transfusion guidelines, infrastructural deficits to high prevalence of transfusion-transmissible infections (TTIs), particularly hepatitis and human immune deficiency viruses. We reviewed available data on blood transfusion practices and safety in Nigeria using the PubMed, PubMed Central, Google Scholar, and African Index Medicus search engines, through a combination of word and phrases relevant to the subject. The World Health Organization has been in the forefront of efforts to establish safe, available, and affordable blood transfusion services in most parts of Africa through encouraging adequate blood donor recruitment, donor blood testing, and collection as well developing strategies for the rational use of blood. Even though modest improvement has been recorded, particularly with regards to donor blood screening for common TTIs, considerable efforts are needed in the form of robust public enlightenment campaigns (on blood donation) and continuous system improvement to drive the current transfusion practices in the country toward safety and self-sustenance.